Bradford’s NHS staff belong in the NHS not tax dodging privateers

We fully support UNISON members on strike in Bradford against transfer into Wholly Owned Subsidiary, setting an example for the rest of the NHS workforce.Over 200 UNISON members at Bradford Teaching Hospitals Foundation Trust (BTHFT) voted to take strike action (97% of those voting) after the Trust unveiled plans to set up a Wholly Owned Subsidiary Company (WOSC) – securing a 70% turnout. The Trust wants to transfer around 600 staff from its estates, facilities and clinical engineering departments into the new company, but denies it is privatising services. UNISON members want to stay employed within the NHS to ensure they retain NHS conditions of service – and remain part of the NHS ‘family’ and an integral part of the Bradford team.8th July was the first day of a week of strike action and saw around 150 UNISON pickets covering all four hospital entrances together with members of the public and supporters (including Leeds Keep Our NHS Public). There was a very clear message for management – those on strike fully intend to win this dispute and stay within the NHS. Huge numbers of public passers by and those visiting the hospital indicated their support for the UNISON members on the picket lines.Business cases for WOSC have largely depended on tax avoidance while blatantly disregarding the lip service usually paid by managers to the importance of team working and the positive benefits this has for patients. The Trust wants the new company, Bradford Healthcare Facilities Management Ltd (BHFML), to operate from 1 October 2019, and say this is essential for delivering efficiency savings. It anticipates that as BHFML grows, it will make an increasing profit and will be able to seek new business opportunities releasing cash from “tax efficiencies” (https://www.bradfordhospitals.nhs.uk/2019/07/05/development-of-a-wholly-owned-subsidiary-at-bradford-teaching-hospitals/).The Trust is at pains to argue that this is not privatisation: “the creation of a WOS company is not privatisation”. This claim must be rejected not least on the basis of the widely accepted typology of privatisation (see: Peedell C. BMJ 2011;342:d2996 doi: 10.1136/bmj.d2996) which encompasses the following:
(a) divestiture or outright sale of public sector assets in which the state divests itself of public assets to private owners
(b) franchising or contracting out to private, for profit, or not for profit providers
(c) self management, wherein providers are given autonomy to generate and spend resources
(d) market liberalisation or deregulation to actively promote growth of the private health sector through various incentive mechanisms
(e) withdrawal from state provision, wherein the private sector grows rapidly as a result of the failure on the part of the government to meet the healthcare demands of the people
It is clear from the above that setting up a WOSC falls into category c. UNISON members in Bradford are united in their opposition to these plans and deserve the support of NHS campaigners and the wider public.John PuntisFrom BRI WebsiteA new wholly-owned subsidiary at Bradford Teaching HospitalsUNISON members in Estates and Facilities at Bradford Teaching Hospitals NHS Foundation Trust are taking industrial action over the establishment of a wholly owned subsidiary company for Estates, Facilities and Clinical Engineering services.
This industrial action will take place from 6am on Monday, 8 July, to 6am on Monday, 15 July. This will affect all the Trust’s hospitals, including Bradford Royal Infirmary and St Luke’s Hospital.Arrangements have been made to ensure that patient safety and levels of care are not compromised by this action and all essential services, such as emergency and urgent surgery, will continue as normal. Patients should attend their routine clinics and appointments as normal unless notified otherwise.There will be picket lines outside the entrances to the Trust’s hospitals and we expect that pickets will behave in a responsible way; they will not be allowed to obstruct or intimidate patients and visitors and you will be able to gain admission to all our hospitals as normal.Similarly patients and visitors coming into our hospitals, crossing picket lines will also be expected to behave respectfully and refrain from using threatening or abusive behaviour towards the pickets. Drivers coming into hospital premises on the days of the industrial action are asked to exercise extra due care and attention when approaching or driving past/through a picket line and should not drive in a manner which could put people at risk or cause injury.Development of a wholly owned subsidiary company for Estates, Facilities and Clinical Engineering services and why we are doing thisBradford Teaching Hospitals NHS Foundation Trust is setting up a wholly owned subsidiary company (WOS) for our Estates, Facilities and Clinical Engineering services, which will be entirely owned by the Trust. The new company, Bradford Healthcare Facilities Management Ltd (BHFML), will operate from 1 October 2019.
Every year the Trust has to deliver efficiency savings – about 4% of turnover (roughly £16m) in the current year. The Trust must take all steps to protect frontline services and provide safe and effective patient care.If we do nothing, and as we make year on year efficiencies, it will be increasingly difficult for our support services to continue as they are now, which will likely impact directly on patient care. Rather than wait for the inevitable contraction and decline, we want to use our scale and expertise to build up the business and win additional work to reinforce the core NHS support service.As BHFML grows, and makes an increasing profit, the level of reinvestment will also increase, which will further improve its operational and financial strength and help ensure sustainability for these services.BHFML will be able to seek new business opportunities on a level playing field with other commercial companies, as its tax arrangements will be the same. Cash released from tax efficiencies will allow us to reinvest in patient care, the hospital estate and BHFML staff development.The creation of a WOS company is not privatisation. The Trust Board has explicitly decided against outsourcing our Estates, Facilities and Clinical Engineering services because we believe we wouldn’t be able to retain the same level of influence over the quality of the service, or guarantee protection for staff terms and conditions in the long-term. Furthermore, we want these services to continue to work to the core Trust values and be part of the NHS family.Once we set the company up, staff will keep their NHS identity and be employed directly by an NHS-owned company – BHFML. The Trust Board is clear that setting up the new company is the only model which allows us to protect around 600 members of staff and protect patient care.
What will happen to staff terms and conditions, and the NHS identity?
Following a period of engagement with staff and trade unions, we are now in the TUPE (Transfer of Undertakings – Protection of Employment) consultation phase ahead of the transfer of staff to BHFML on 1 October 2019.
As part of TUPE legislation all affected staff will have their terms and conditions protected. In addition, the Trust’s Board has guaranteed to protect their terms and conditions for as long as the new company has the contract with the Trust, which is 25 years.
We have also had a guarantee from NHS Business Services Authority that existing staff will continue to have access to the NHS Pension scheme. We will protect terms and conditions if staff get promoted, or increase or reduce their hours, and we will look to match the annual NHS pay awards.
We have listened to concerns from our staff and union colleagues and agree that we should not have a two-tier workforce. That’s why we have also taken an additional step, going above and beyond what any subsidiary company in the region is doing, by offering terms and conditions for new starters that are comparable to the national NHS Agenda for Change terms and conditions that existing staff will transfer on.
Staff who work in Estates and Facilities as part of the Staff Bank (the Trust’s temporary staff register) will have the same opportunity to work for BHFML as they do now and on the same rates of pay as now.
And in the highly unlikely situation that BHFML fails or the contract is ended sooner than the 25 year period, all services will transfer back to the Trust; and this will be built into the legal contract documents between the Trust and BHFML.
BHFML will have access to the Trust’s payroll, IT services, HR, parking permits, lease car scheme, childcare services, training courses, and health and wellbeing services.
Our people, our future
Within Estates, Facilities and Clinical Engineering services we have a highly skilled, knowledgeable and motivated team of staff who do an excellent job.
Over the years these teams have innovated, adapted to new demands and kept delivering high quality services day in, day out, but with increasing financial challenges in the NHS it is getting harder to maximise quality and value for money without significant change.
We want to sustain and develop these services for future years: that’s why it is essential for us to develop BHFML and grow the business so it becomes more sustainable, successful and secure for everyone who works there.
The Trust will hand over decision-making to the new company so it can decide how to develop its staff, and have a commercial strategy to focus on growing the business, such as in GP practices and local schools, in addition to its main NHS contract.
But the Board of Bradford Teaching Hospitals will be able to ‘reserve’ some decision-making rights so that the company must always seek agreement of the Trust Board on these matters. This is one of the key safeguards we can put in place to address concerns that those who work in the new company will be at more risk than if they had stayed directly employed by the Trust.
BHFML will be better placed to work with small and medium-sized businesses locally which are not usually able to work with the NHS due to their size. By growing the business it will also mean we can provide additional employment, training and development for local people.
We have every confidence that BHFML will be a successful organisation that values its staff and supports both patient care and our local economy.

Keep Our NHS Public national AGM

KONP_AGM_June_15th_2019

Integrated_Care_Systems_notes_John_fromKings_Fund_and_Sally_R’s_BMJ_piece_June_19

What a crucial time to have the AGM, with loads of helpful info on campaigning in both documents – please read and share widely

Northern Health Campaigns Together 29th June and other events

1. Sat. June 29th : Health Campaigns Together Conference in Leeds.

The Conference should help us get a better handle on what is happening in health and social care, share experience and talk about what can be done but also recharge our batteries and derive strength from each other .

2. Thursday 13th June to Sat. 5th July . See Space 2’s “ Many Happy Returns :70 years of NHS memories “ exhibition in room 700 at Leeds City Library. We co-operated closely with Space 2 in preparation for the exhibition and it does show !

3. Friday July 5th ( and possibly Sat 6th too) NHS Birthday event – details to be discussed but we will definitely have a lunchtime event on 5th and will be trying to make some links with Space 2’s exhibition. Plans to be made at the next KONP mtg. on Wed 26th June.

4. Saturday 13th July Kirkstall Festival 10-4 ish We have taken over the stall usually run by Leeds Hospital Alert so need lots of help and bright ideas about how to make it interesting & attractive.

5. Friday 20th September: ( almost confirmed) Banner Theatre musical/ multi-media production on the NHS at Seven Arts, Chapel Allerton

6. Sat 28th September : KONP / HCT National Conference on Mental Health at the Royal Free Hospital London.

DATE OF NEXT MEETING : Wednesday 26th June 6.30 – 8pm in the Victoria Hotel

Tomorrow – important meeting on integrated care in Yorkshire

Don’t miss Leeds KONP meeting tomorrow wed 12th 6.30-8pm in the Victoria Hotel behind Leeds Town Hall. ! At the last meeting we agreed to reserve most of this meeting to decide on what we should be asking Leeds LA in particular to do regarding the very rapidly developing Integrated Care System in West Yorks & Harrogate . Time is of the essence!

No prep required but if you feel up to some reading in advance you might like to have a look at these documents:

West_Yorkshire_&_Harrogate_Integrated__Care_Partnership_or_System_summary_June_16j

Integrated_Care_Systems_notes_from_John_6.19

Konp_Leeds_Integrated_Care_Systems_draft_letter_to_councillors_10.18

Hope to see you tomorrow

Join us tomorrow evening

Everyone is very welcome to the next Leeds Keep Our NHS Public meeting this Wed 29th6.30 – 8pm in the Victoria Hotel ( Bridget’s room) immediately behind Leeds Town Hall.

We will be discussing the latest NHS news, the new GP contract and the development of primary care networks and Integrated Care partnerships.

Planning will focus on

Ø The Northern Health Campaigns Together Conference in Leeds on 29thJune -publicity and organisation.

Ø A meeting with Angela Raynor, Jane Aitchison et al in Pudsey at 2pm on June 1st as part of a Labour Roots meet campaigners initiative. The Pudsey meeting focuses on public services. Places are limited and you need to request an invitation here. I have also been asked to give the organisers an idea of the numbers from Leeds KONP so if you can let me know if you are coming that would be helpful. There is also a LP rally in the Armouries at 6pm on 1stJune. .

Ø potential Leeds KONP stalls on 1st and 8th June

Ø the KONP AGM in London on 15th June. John Lister and Cat Hobbs from ‘We Own It’ will be talking about privatisation, Dr. Helen Salisbury, an Oxford GP and BMJ columnist will be talking about ‘Integration- What Kind of NHS Services do we want ?’ and James Skinner from MEDACT and Sophie Williams from Docs Not Cops will talk about “Hostile environment in the NHS ; Migrant Charges”. Join KONP and register for the Conference at https://tinyurl.com/y53wacfs . We also need to think about whether we want to submit a motion to the AGM

Ø Marion McAlpine’s photographic exhibition on privatisation in the NHS.. Keighley Library are showing it from May 29th to June 8th but Leeds Library have turned it down. Any other ideas welcome as it would be good to keep it up north at least until the Conference on 29thJune.

Ø Space 2’s exhibition on the NHS birthday will be in the Central Library from 13th June to 5th July.

Ø NHS 71st birthday Friday July 5th – we need to start planning our protest( s) / celebration

Primary Care Networks – how do we campaign for primary care?

Apologies – now updated link:

https://leedskeepournhspublic.files.wordpress.com/2019/05/pcn.pdf

From Healthwatch and Public Involvement Association:

Primary Care Networks: Frequently Asked Questions

Please find below a number of frequently asked questions about Primary Care Networks that have come through various engagement sessions. If your question is not listed below, you can send this to the Primary Care Network national team who will share a response england.pcn@nhs.net

These frequently asked questions are also available as a PDF document: Primary Care Networks: Frequently Asked Questions

What is a primary care network (PCN)?

A primary care network consists of groups of general practices working together with a range of local providers, including across primary care, community services, social care and the voluntary sector, to offer more personalised, coordinated health and social care to their local populations. Networks would normally be based around natural local communities typically serving populations of at least 30,000 and not tending to exceed 50,000. They should be small enough to maintain the traditional strengths of general practice but at the same time large enough to provide resilience and support the development of integrated teams.

Can you be a PCN without signing up to the new Network Contract DES?

General practice is at the core of any PCN and £1,799 billion will be made available to GP practices in PCNs via the Network Contract DES by 2023/24 as well as an additional £14,000 each year that a typical practice will receive from April 2019, in return for their initial and then continued active participation in a Primary Care Network.  We are committed to 100% geographical coverage of the Network Contract DES by 1 July 2019.  PCNs will need to sign up to the Network Contract Directed Enhanced Service to be able to benefit from the investment to be allocated through it.

Which organisations form part of a primary care network?

Primary care networks will be expected to have a wide-reaching membership, led by groups of general practices. This should include providers from the local system such as community pharmacy, optometrists, dental providers, social care providers, voluntary sector organisations, community services providers or local government.

What are PCNs designed to do?

Primary care networks will provide proactive, coordinated care to their local populations, in different ways to match different people’s needs, with a strong focus on prevention and personalised care. This means supporting patients to make informed decisions about their own health and care and connecting them to a wide range of statutory and voluntary services to ensure they can access the care they need first time. Networks will also have a greater focus on population health and addressing health inequalities in their local area, using data and technology to inform the delivery of population scale care models. As an example, this will be supported by the introduction of a new Tackling Neighbourhood Inequalities Service Specification to be delivered by PCNs signed up to the Network Contract DES from 2021/22.

Primary care networks will also help ensure that the NHS designs support and services to get the best possible value out of their funding for their local communities.

How many PCNs currently exist across the country?

As of 30 November 2018, 93.4% of practices across England considered themselves to be part of a network. This is based on CCG responses to the monthly GP Forward View Monitoring Survey.  In light of the more detailed information included in the Long Term Plan and “Investment and evolution: A five-year framework for GP contract reform to implement The NHS Long Term Plan” about the role and requirements of PCNs, groups of practices will be reviewing their position.  PCNs will exist formally once they have met registration requirements for the GP contract Network Directed Enhanced Service (DES) and been approved by their commissioner. The Network DES will start from 1 July 2019.  Information is available in the recently published “Investment and evolution: A five-year framework for GP contract reform to implement The NHS Long Term Plan”.

How would members of each PCN be decided?

Membership of a primary care network will be down to local agreement, dependent on the needs of the local population. However, each PCN should have a boundary that makes sense to: (a) its constituent practices; (b) to other community-based providers, who configure their teams accordingly; and (c) to its local community, and which typically covers a population of at least 30,000 and not tend to exceed 50,000. Each PCN will be required to appoint a named accountable Clinical Director who does not have to be a GP. Information is available in the recently published “Investment and evolution: A five-year framework for GP contract reform to implement The NHS Long Term Plan”.

What are the core characteristics of a PCN?

The core characteristics of a PCN are:

  • Practices working together and with other local health and care providers, around natural local communities that geographically make sense, to provide coordinated care through integrated teams
  • Typically a defined patient population of at least 30,000 and tend not to exceed 50,000
  • Providing care in different ways to match different people’s needs, including flexible access to advice and support for ‘healthier’ sections of the population, and joined up care for those with complex conditions
  • Focus on prevention and personalised care, supporting patients to make informed decisions about their care and look after their own health, by connecting them with the full range of statutory and voluntary services
  • Use of data and technology to assess population health needs and health inequalities; to inform, design and deliver practice and populations scale care models; support clinical decision making, and monitor performance and variation to inform continuous service improvement
  • Making best use of collective resources across practices and other local health and care providers to allow greater resilience, more sustainable workload and access to a larger range of professional groups.

How does a PCN differ from a GP federation?

A GP federation is generally a group of practices that come together to deliver services whereas a PCN is a broader collaboration of practices and other health and care partners’. There is also published material from the BMA and RCGP about the different structures federations can take. These are not mutually exclusive and can co-exist to deliver a broader set of integrated out of hospital services for their local communities. Work is underway to better understand/set out the relationship between PCNs and federations using practical examples.

Will areas that already have established federations need to change their delivery plans to fit smaller scales?

PCNs will typically serve populations of at least 30,000 and not tend to exceed 50,000. This is because they need to operate at a level which maximises economies of scale, but is small enough to ensure understanding of local population needs. PCNs can be bigger than 50,000 if they meet all the registration requirements under the Network Contract DES but in reality, may require organising themselves into smaller neighbourhood teams within the 30,000 to 50,000 population size. But it would create extra bureaucracy to require each of these internal teams to register as a separate network.

The guidance around PCN size is provided to help areas early in their journey of developing PCNs have some structure to work around. It is anticipated that those PCNs with very different sizes will be able to articulate a clear reason why; and how they are working in a network way with other partners.

If a PCN is smaller or larger than the 30-50,000 population as noted in the reference guide, will this be an issue?

PCNs will typically serve populations of at least 30,000 and not tend to exceed 50,000. This is because they need to operate at a level which maximises economies of scale, but is small enough to ensure understanding of local population needs.

In exceptional circumstances commissioners can agree to vary the 30,000-population floor most likely where there is a low population density across large rural and remote areas.

PCNs can be bigger than 50,000 if they meet all the registration requirements but in reality, may require organising themselves into smaller neighbourhood teams within the 30,000 to 50,000 population size.

What contracting forms will be available to PCNs to enable them to deliver services / employ staff, receive funds?

The Network Contract will be implemented as a Directed Enhanced Service (DES) for GP practices. It will start from 1 July 2019, subject to primary care networks having met the registration requirements and been approved by their commissioner.  The DES Directions and DES Enhanced Contract Specification will be published by 31 March 2019. Supporting guidance and information will be published at the same time.

Who will hold the Network Contract?

The Network Contract will be a Directed Enhanced Service held by GP practices, and underpinned by a Network Agreement between them. Practices with an in-hours (essential) primary medical care contract will be eligible to sign-up to the DES as part of their network. Federations cannot hold the Network Contract DES.

Given the integrated nature of PCNs, is the GP contract for general practice or for wider groups of providers?

If a PCN doesn’t have a core set of GPs and practices, it isn’t a PCN – the Network Contract DES is a mechanism for flowing funding to PCNs, and general practice is expected to be the  core around which PCNs are built upon.

Who will be accountable for delivering the PCN element of the GP contract, will it be the clinical leads or individual practices?

The Network Contract DES is contractually practice-based. It will be the collective responsibility of the PCN GP practices to deliver.

What if some practices are not included in a network, either through choice or through being left out?

Every practice will have the right to join a Primary Care Network in its CCG, but the Network Contract DES remains voluntary. Close working is needed between Clinical Commissioning Groups and Local Medical Committees to help ensure 100% coverage is achieved.

In the highly unlikely event that a practice doesn’t want to sign-up to the Network Contract DES, its patient list will nonetheless need to be added into one of its local Primary Care Networks to ensure all patients have access to network services. That PCN then takes on the responsibility of the Network Contract DES for the patients of the non-participating practice through a locally commissioned agreement. The practice remains responsible for delivering core contract services to its registered list,

From 1 April 2019, a new SFE Network Participation Payment will be introduced, payable for practice activity to support the delivery of network services to its population, thereby achieving 100% coverage of the population within a PCN. A typical practice will receive over £14,000 each year (this is a practice size of approximately 8,000 patients). This payment will only apply to practices who sign-up to the Network Contract DES on an ongoing basis as an active participant. The payment will be payable from 1 July 2019 following commissioner approval and will be backdated to 1 April 2019.

  1. If funding is to flow at a network level, what is to stop the highest performing practices joining together to get the gains – resulting in a two tier system where lower performers are forced to buddy with similar practices?

We anticipate that practices will work together in geographically coterminous areas, rather than because of historic performance. The ongoing development of PCNs should be reinforced by strong system leadership, which should dispel some of this fear locally.

All Primary Care Networks will have a Network Agreement, even those with one large practice. This is because the Network Agreement is both the means by which the Primary Care Network describes how the practices will work together to discharge the Network contract but also how it will partner with non-GP practice stakeholders. It is needed for the PCN to claim its financial entitlements and deliver national and local services to its whole Network list and area. Delivery and achievement of the contract requirements will depend on collaborative working by network members.

How do you know if you are in a PCN – is there an “official” designation / national recognition or do you just call yourselves a network?

As set out in Investment and evolution: a five-year framework for GP contract reform to implement The NHS Long Term Plan, there will be a registration process whereby PCNs will need to be recognised and meet minimum requirements to sign-up and participate in the Network Contract DES and be eligible to claim financial entitlements. The core characteristics of a primary care network are set out in the PCN reference guide (available in draft at https://future.nhs.uk/connect.ti/P_C_N). Practices should refer to the reference guide to help guide the development of their network and to help provide further details about some of the core components of a PCN. The guide is intended to give a sense of the starting point for a network and each step along the way as practices begin to work together.

How does the governance structure of each PCN work – do you anticipate a board style set up with a clinical lead?

It is a requirement of the Network Contract DES that every primary care network would have a named accountable Clinical Director who does not have to be a GP. However the governance structure within a PCN will be determined locally and recorded as part of completing a nationally mandated Network Agreement. We anticipate there will be a variety of staff engaged in the structure of each network.

If each PCN is to have a Clinical Director, how are these to be appointed?

Each PCN will be required to appoint a named accountable Clinical Director. A description of the role is available in the recently published “Investment and evolution: A five-year framework for GP contract reform to implement The NHS Long Term Plan”. Work is currently underway, as part of the national support offer, to review the core characteristics and skills needed for this role and further information will be made available shortly.

If clinical leadership is seen as key to the development of PCNs, is there funding for this as part of the contract?

A Primary Care Network must appoint a Clinical Director as its named, accountable leader, responsible for delivery.

Together, the Clinical Directors will play a critical role in shaping and supporting their Integrated Care System. They will help ensure the full engagement of primary care in developing and implementing local system plans to implement the NHS Long-Term Plan. These local plans will go much further than the national parts of the Network Contract DES in addressing how each ICS will achieve the commitments set out in the Long Term Plan.

In recognition of the importance of this role and as a contribution to the costs, each Network will receive an additional ongoing entitlement to the equivalent of 0.25 FTE funding per 50,000 population size. The amount will vary in proportion to network list size. The legal entitlement under the Network Contract DES starts from 1 July 2019.

We want to develop our own version of the PCN maturity matrix locally; can we?

PCNs are a critical building block for the development of the NHS to a population focus for health and care improvement. They need to align with and support work at neighbourhood, Place, and System levels. For this reason, it is important that whilst they should develop in a way that meets their specific local needs, they must also provide a consistent level of support and integration with the wider health and care system. The maturity matrix is designed to enable local innovation within a national framework. All systems should use the provided maturity matrix in the first instance to assist with assessing relative maturity of their networks. We are aware that in some instances, building on this maturity matrix and adapting it for local use has led to positive engagement of all networks, which we would encourage.  All PCNs will need to consider the evolving requirements of the Network Contract DES as they mature and plan for this.

Will the PCN maturity matrix be used for performance management?

The maturity matrix is not an assurance vehicle for PCN performance. It is a key tool to be used to assess both current maturity and provide direction to developing PCNs. PCNs will need to consider the evolving requirements of the Network Contract DES as they mature and plan for this.

How do you make GP partnerships (that are separate businesses in their own right) collaborate with other practices/partnerships?

The Network Contract DES will support practice/partnership to achieve collaborative working and the Network Agreement will set out how they will do this.

Where is the evidence that large scale networks are more financially sustainable than individual practices?

Joint working between practices is nothing new.  The new Network Contract DES provides significant funding to support practices to formally work together, irrespective of their individual motivations for doing so.

There have been a number of reports conducted into the sustainability of primary care networks all over the world.

A selection of these can be found below:

How do you balance these proposals against the evidence that patients get better care from small practices that provide the most continuity?

The development of PCNs does not take away the need for a local neighbourhood ‘presence’ in terms of a GP practice, it enables a local focus set in the context of collaborations that bring together those services that need to be provided at scale. A PCN approach will drive continuity of care for those patients with complex long term conditions as ultimately it will ‘free up’ GP time to focus in more complex areas whilst using alternative practitioners to see those with routine needs. A PCN’s role is about looking at the population health needs and this is will involve working with patients and the public to understand their needs and requirements to deliver the best solutions to meet these.  This will involve balancing for example choice and convenience of services and the scale the services are delivered at.

To read about the research completed on continuity of care and primary care networks

What monitoring and assurance will the national team be asking of CCGs?

We are working with local teams to develop an appropriate approach that helps provide the right level of assurance. This will initially focus on confirming practices are all part of a PCN by the end of June 2019.

CCGs (or NHSE local teams for the small number of CCGs without delegated primary care commissioning), will be responsible for overseeing the Network Contract DES registration process and ongoing assurance of PCNs’ delivery against the requirements of the DES. A new Primary Care Network Dashboard will be introduced from April 2020 to support the assurance process. CCGs, working with LMCs, must ensure all practice lists are covered by a Primary Care Network in their area for the provision of network services.

What is the PCN development programme?

The PCN development offer will provide support to the system to meet policy commitments and enable the creation of effective and sustainable PCNs. It will have a focus on providing capacity to local teams and building capability in two key areas:

  • Leadership development (including relationship management)
  • Organisational development (including team development and change management)

Delivery options for the development support offer are still being agreed.

How do you envisage securing and funding sufficient and appropriate local organisational development (OD) capacity and expertise?

We have carried out significant engagement with the system and continue to do so as we develop the PCN offer.  Our aim is to ensure that we secure ‘the right’ support and that it gets to ‘the right’ place based on need. The support must add value and not duplicate offers that are already available.  Understanding the local context is essential to this, hence the focus on engaging with the system and regions.

What will the process be to access the development offer funding?

The process to access the PCN development support offer is still in discussion. However, it is likely that funding will flow to ICS/STPs for them to draw down specific development support from a nationally agreed framework based on their local needs.

Have LMCs been involved in decisions on how development funding will be allocated?

The national team have engaged with a range of stakeholders which has included local LMC representatives, regional teams, CCGs and primary care staff, including GP federations and practice managers in designing the primary care networks development programme.

There is a lot of health and care wider work being implemented in relation to PCNs, however some areas are broader that – working with schools, community development, fire service etc. When NHS England talks about funding and support, are we talking specifically about funding general practice to develop PCNs, or is this funding for systems to develop integrated working?

Any funding specific to PCN development will need to be used based on the needs of the local system. Nationally we would support using the development funding to support integrated working, however the decision about this will be for local determination.

Is the support offer aimed at practices or all partners of a primary care network?

All practices and partners within a PCN, in line with local context and need.

Who will be providing the development support offer – will it be CSUs or an external provider?

Work is underway to determine the best way to deliver the development support needed by the system. It is likely that there will be a ‘menu of support’ covering a number of elements which will be provided by a variety of providers.

What do you mean by values and behaviours on your leadership development support?

This is about giving teams the space to discuss the sort of environment that they would like to work in, what values are important to them so that local teams can develop a culture whereby staff feel valued and supported and are aligned with the values of the NHS. By behaviours we mean leading by example, whatever role you may be in, it is about treating others with dignity and respect.

Many ICSs have recognised that much of the PCN maturity matrix (especially stages 2 and 3) is dependent on developing population health management skills and capability. Will there be any provision for this in the support offer?

Support is already being provided to ICSs to help them build population health management capabilities to turn data into actionable insight for primary care networks and integrated teams. The learning from this early work is being bought together to provide a range of practical resources and further advice and support. To access the practical guidance and learning to date, please email england.STGPHM@nhs.net to join the PHM Network.

Are there opportunities for networks to help improve workforce health and wellbeing (which might be challenging at practice level), and is this something that would be supported as part of the development support offer?

Yes, this is integral to the development offer that is being developed based on feedback from the recent workshops and is exactly where we want to focus resources.

How will the time for care programme be used going forward to support the OD and QI skills to be developed across general practice? Will the programme be continued beyond March 2019, and in what context?

The Time For Care Programme is continuing in 2019/20 and beyond. The programme will continue to focus on quality improvement and change management working with practices, groups of practices and PCNs depending on local need.

Is this a replica of the NAPC offer?

NHS England has worked with NAPC to provide support to local areas to develop Primary Care Homes (PCH).  The NAPC Primary Care Homes approach has created a number of strong demonstrators of how excellent PCNs will work in the future and has informed our approach to designing PCNs, but it is not the only model. The NHS England PCN development programme will be designed to offer a range of support whereby ICS/STPs can draw down support relevant to them and their local PCN needs. Local systems should work with the partners who can best support the approach to PCN development that fits with local ambitions.

Is consideration being given to core contracts development for dentistry, pharmacy and optometry so they dovetail with what is being asked of medical primary care to align strategic direction of travel for all?

The national PCN programme team are linking with a number of stakeholders to ensure all future planning is aligned.

Are there any examples or resources available for us to share with practices on what’s worked well?

Further examples and case studies are available on the NHS England website at www.england.nhs.uk/pcn. Information is also being shared via weekly webinars involving presentations from local areas who are already working as part of primary care networks. Full details are listed on the above web page.

Additional resources and guidance related to the development of primary care networks are also available on the primary care networks FutureNHS site at https://future.nhs.uk/connect.ti/P_C_N/grouphome and further documents are being produced. Please email england.pcn@nhs.net to request an invitation to join to platform.

How can I contact the national PCN team with any further questions?

Please email england.pcn@nhs.net and a member of the team will be in touch.

Latest news

Opportunities for influencing Labour policy:

Individuals and groups can read Labour’s key policy papers on line and contribute comments, criticisms
ideas etc . There are also 2 papers on forms of ownership and co-production of services. ( Alternative
Models of Ownership and Democratic Public Ownership.

We can put motions through branches and CLPs to Conference. D noted that for the first time this
year branches can put motions relatively late in the day without them having to flit the slot as a
contemporary motion. S/he thinks the deadline is late July.

We can try to influence the local election manifesto. This was attempted via the campaign group mtg, for the recent election but most of the input from KONP LP supporters didn’t make the final cut which
focused more on Labour’s local achievements such as having developed much better preventative
services in mental health.

In discussion, the local councillors say that there is little they can do about
the big political issues. What was folded into the manifesto was a commitment to give local people
open and honest information about wat is happening

We can raise issues/ make challenges to local councillors via direct meetings, e mails or letters. In
response to a question, we thought we had some impact doing this in 2018 when the ACOs were mooted and when the LA was asked to sign up to a Memorandum of Understanding for
setting up the West Yorks and Harrogate Integrated Care Partnership.

The Council refused to sign the NHS’s initial draft MOU and managed to get some significant alterations ( on paper !) regarding recognition of the social determinants of health, commitment to more transparency and accountability, avoiding being pinned down to a control total etc. etc.

West Yorks Campaigners have also had some influence in getting the Council to formally set up a West Yorks and Harrogate Joint
Scrutiny Board to scrutinise developments with the W Y&H Integrated Care Partnership/System.

In addition we can and do ask questions at Health and Wellbeing Board, joint West Yorks and Harrogate Scrutiny Board and local and West Yorks CCC meetings. There is no slot for questions at Leeds Scrutiny
Board although this is something we should take up. We could submit an issue for Scrutiny. If accepted
this would mean we get the opportunity to speak to the Board.

KONP is on the list to be invited to meet with Shadow Ministers et al in Leeds on June 1st, assuming
their visit to Leeds comes off. The plan is for several different sessions in different areas of Leeds, each
involving a mixed bag of local campaigns/ campaigners.

Influencing LP policy and Practice:

John Ashworth, Shadow Minister for Health has been talking to KONP and Health Campaigns Together. At
the recent HCT AGM he endorsed the broad sweep of our demands and the Reinstatement Bill. Barbara
Keeley , shadow minister for Social Care is doesn’t seem to be in the same space.

Local Councillors should be demanding that they have a say and we should be trying to persuade labour that it is not enough just to be preparing for Government ; they
should be building opposition at a local level.
We had a wide ranging discussion and identified a number of areas where we should be seeking to involve
and challenge the labour Party

Resolutions to Conference
2017 Conference reference back of the NHs policy and good resolution passed calling for non co-operation with Accountable Care Organisations has probably only just worked its ways through LP procedures so is still extant. No one was aware of any new draft motions to this Conference in circulation.

It is understood that the LP accept the gist of the NHs Reinstatement Bill .
Action :
– check whether the Socialist Health Association, KONP or anyone else close has a draft motion and
consider whether and what we might want to put to branches/CLPs.
– Ask people to put the Social care motion already circulating. Already putting it to Kirkstall branch

Working around Elections
Action:

We should consider producing a flier to use in the Euro elections and be prepared with a strategy if / when a general election is called. ( hustings ? , eliciting and publicising candidates’ commitments on
the NHS and Social Care / pledges etc.

Social care:

Action
We need to do more to challenge councillors to
– raise an outcry re shrinking social care services, patchwork of private providers, poor quality,
inadequate training and high staff turnover, undervaluing of the care economy etc
– bring domiciliary services back into public control – reverse outsourcing
– insist on ethical commissioning : living wage , standards of training , social value etc

Local privatisation CAMHS , private wards:
Sylvia has been taking up major concerns re the building of a new Child and Adolescent mental health Unit on St. Mary’s Hospital with MP Rachel Reeves et al on behalf of Leeds Hospital alert and Unison Retired
members are now supporting.

Interserve has the contract for building the unit and a fair degree of running it but they have gone bust / into administration, although there are manoeuvres to keep running.
Villa Care are running 5 step down wards within the NHs to try to get people off acute wards as there not
as there are not enough beds for new people. Many can’t go home because social services aren’t in place.

We need to get clear exactly what is happening now with Interserve and CAMHS and take this up widely with Labour MPs and councillors. We also need to publicise and challenge the use of Villa Care and the wards which are essentially warehousing people largely because of gross underfunding of Social Care.

Rapidly creeping changes in GP service/ Primary care:
John noted that GPs are being pressured into signing up to a new primary care network contract and by
carrot and stick ( bullying by any other name – G).

GPs are retiring faster than they can be replaced; they are struggling with endless new demands; people are waiting too long to see a GP, tasks are being pushed down a skills chain, the individual doctor patient relationship is on the way out, digital firms like Babylon are keen to move out of London and have mentioned Leeds.
Action
We need to take up campaigning / protesting about the shrinking and fragmenting of the GP service
with public and GPs and urge local Labour to get involved. KONP have just produced a draft primary
care charter, 999 and others are asking GPs not to sign up.
John is talking to /with SHA about this this weekend and we need to get our position firmed up and a campaign strategy implemented locally.

Migrant Charges, not right, not fair, not financially fruitful, risks individual and public health and thin
end of wedge:
Action
-Talk to the Trade Unions re launching a joint campaign and involve organisations s for asylum seekers .
( The Conference on 29.6 will raise the issue)
– Publicise through fliers, letter to YEP, facebook etc,
– press Labour to take up the issue with us.

NEXT MEETING Wed 29th May 6.30 – 8pm in the Victoria Hotel
NB Join the LEEDS KONP banner at Banners held High in Wakefiled Sat 18th May 11.30pm
in Smythe St. near Westgate Station